CDCES Class 5: Insulin, Sick Days, Hospital, and Feet

Vocabulary practice flashcards covering insulin dosing calculations, inpatient protocols, sick-day rules, CGM metrics, perioperative medication management, and diabetic foot care guidelines from CDCES Class 5.

Total Daily Dose (TDD) Starting Formula

The standard calculation to initiate insulin therapy, usually calculated as weight in $\text{kg} \times 0.5\,\text{units/kg}$. A reduced multiplier of $0.3\,\text{units/kg}$ is used for individuals who are thin, elderly, or have impaired kidney function, while $1.0\,\text{units/kg}$ is used for patients with heavy weight, infection, or steroid use.

50/50 Rule

A standard insulin regimen framework where $50\%$ of the total daily dose (TDD) is delivered as basal insulin and the remaining $50\%$ is administered as bolus insulin divided across three meals.

500 Rule (Carb-to-Insulin Ratio)

The formula used for rapid-acting insulin analogs (lispro, aspart, glulisine) calculated as $500 \div \text{TDD}$, determining the grams of carbohydrate covered by $1\,\text{unit}$ of insulin (commonly starting at $1\,\text{unit per } 15\,\text{g}$).

450 Rule

The formula ($450 \div \text{TDD}$) used to determine the carb-to-insulin ratio (CIR) specifically for short-acting Regular (human) insulin.

Insulin Correction Factor (ICF)

Also called insulin sensitivity factor; defines how many points (mg/dL) $1\,\text{unit}$ of insulin lowers blood glucose. Calculated as $1700 \div \text{TDD}$ (or $1800 \div \text{TDD}$) for rapid-acting analogs and $1500 \div \text{TDD}$ for Regular human insulin.

1700 Rule

An insulin sensitivity formula ($1700 \div \text{TDD}$) applied to rapid-acting analogs to find the correction factor. For example, a TDD of $50\,\text{units}$ yields $1700 \div 50 = 34\,\text{points}$ per unit of insulin.

Pre-Meal Hypoglycemia Bolus Adjustment

A clinical rule directing that if a patient's pre-meal blood glucose is below $70$, $1\,\text{unit}$ of insulin is subtracted from the total calculated meal bolus.

High Fasting Morning Glucose (Clinical Significance)

A pattern of elevated waking blood glucose that reflects the action and adequacy of basal insulin (e.g., glargine, degludec, or bedtime NPH), requiring an adjustment to basal dosing rather than meal boluses.

High Pre-Dinner Glucose (Clinical Significance)

A blood glucose pattern that directly reflects the performance and dosing adequacy of the previous meal's (lunch) bolus insulin, indicating a need to adjust lunch bolus.

2-Hour Postprandial Target

The post-meal evaluation point used to determine whether a mealtime bolus was properly dosed, targeting a blood glucose value under $180$.

Regular Insulin

A short-acting human insulin with identical structure to endogenous insulin, dosed using the 450 rule for carbohydrate coverage and the 1500 rule for sensitivity correction.

CGM Time in Range (TIR) Goals

Continuous glucose monitoring targets: greater than $70\%$ in the target range ($70\text{--}180$), less than $4\%$ below $70$, less than $1\%$ below $54$, less than $25\%$ above $180$, and less than $5\%$ above $250$.

Ambulatory Glucose Profile (AGP) Review Priority

The systematic clinical practice of identifying and correcting hypoglycemic events first (specifically very low readings exceeding $1\%$) and actively asking the patient what they see in the report.

Sick-Day Medication Protocol

The requirement to hold SGLT-2 inhibitors during acute illness to prevent diabetic ketoacidosis (DKA), while continuing other diabetes medications and insulin, monitoring blood glucose every $4\,\text{hours}$, and checking ketones if glucose exceeds $240$.

Inpatient Glucose Targets

Target blood glucose ranges in the hospital setting: $100\text{--}180$ for medical-surgical and perioperative units, and $140\text{--}180$ for critical care (ICU) settings.

Inadvertent Bolus in NPO Surgical Patient Management

The protocol of hanging an intravenous infusion of $5\text{--}10\%$ dextrose and alerting anesthesia immediately when bolus insulin has been accidentally given to an NPO patient scheduled for immediate surgery.

Preoperative Basal Insulin Adjustment

The perioperative dosing guideline recommending that patients receive $75\text{--}80\%$ of their normal long-acting analog basal insulin dose or $50\%$ of their NPH dose prior to surgery, while holding oral medications the morning of the procedure.

Preoperative SGLT-2 Inhibitor Holding Timeline

The mandate to discontinue SGLT-2 inhibitors $3\,\text{days}$ prior to surgery ($4\,\text{days}$ for ertugliflozin) to reduce the risk of postoperative euglycemic DKA.

Preoperative GLP-1 Receptor Agonist Holding Timeline

The clinical standard requiring weekly GLP-1 receptor agonists to be held for $7\,\text{days}$ prior to surgery and daily GLP-1 receptor agonists to be held on the day of surgery.

5.07 Monofilament Test

A neurological assessment tool that applies $10\,\text{g}$ of calibrated pressure to specific sites on the foot to detect loss of protective sensation (LOPS).

Medicare Part B Therapeutic Footwear Benefit

An annual coverage benefit for qualifying patients with diabetes and high-risk foot conditions providing either $1\,\text{pair}$ of depth shoes plus $3\,\text{pairs}$ of inserts, or $1\,\text{pair}$ of custom-molded shoes plus $2\,\text{pairs}$ of inserts.

Medicare Part B Test Strip Coverage (Non-Insulin T2D)

The standard Medicare Part B supply allowance providing $100\,\text{test strips}$ every $3\,\text{months}$ for individuals with type 2 diabetes managed with non-insulin oral medications.

Return Demonstration

The most effective instructional method for blood glucose monitoring where the patient demonstrates the steps back to the educator, validating competency and preventing user error.

Post-Meal Inpatient Bolus Dosing

The administration strategy of giving mealtime bolus insulin after eating based on the actual carbohydrate amount consumed, indicated for hospitalized patients experiencing nausea or erratic oral intake.